Sprains and strains

Definition

Sprains and strains are common injuries that share similar signs and symptoms, but involve different parts of your body.

A sprain is a stretching or tearing of ligaments — the tough bands of fibrous tissue that connect two bones together in your joints. The most common location for a sprain is in your ankle.

A strain is a stretching or tearing of muscle or tendon. A tendon is a fibrous cord of tissue that connects muscles to bones. Strains often occur in the lower back and in the hamstring muscle in the back of your thigh.

Initial treatment for both sprains and strains includes rest, ice, compression and elevation. Mild sprains and strains can be successfully treated at home. Severe sprains and strains sometimes require surgery to repair torn ligaments, muscles or tendons.

Symptoms

Signs and symptoms will vary, depending on the severity of the injury.

Sprains

Pain

Swelling

Bruising

Limited ability to move the affected joint

At the time of injury, you may hear or feel a "pop" in your joint

Strains

Pain

Swelling

Muscle spasms

Limited ability to move the affected muscle

When to see a doctor

Mild sprains and strains can be treated at home. But the injuries that cause sprains can also cause serious injuries, such as fractures. You should see a doctor if you:

Can't walk more than four steps without significant pain

Can't move the affected joint

Have pain directly over the bones of an injured joint

Have numbness in any part of the injured area

Sprained ankle

A sprained ankle is the stretching or tearing of ankle ligaments, which support the joint by connecting bones to each other.

Causes

Sprains

A sprain occurs when you overextend or tear a ligament while severely stressing a joint. Sprains often occur in the following circumstances:

Ankle — Walking or exercising on an uneven surface

Knee — Pivoting during an athletic activity

Wrist — Landing on an outstretched hand during a fall

Thumb — Skiing injury or overextension when playing racquet sports, such as tennis

Strains

There are two types of strains: acute and chronic. An acute strain occurs when a muscle becomes strained or pulled — or may even tear — when it stretches unusually far or abruptly. Acute strains often occur in the following ways:

Slipping on ice

Running, jumping or throwing

Lifting a heavy object or lifting in an awkward position

A chronic strain results from prolonged, repetitive movement of a muscle. This may occur on the job or during sports, such as:

Gymnastics

Tennis

Rowing

Golf

Risk factors

Factors contributing to sprains and strains include:

Poor conditioning. Lack of conditioning can leave your muscles weak and more likely to sustain injury.

Fatigue. Tired muscles are less likely to provide good support for your joints. When you're tired, you're also more likely to succumb to forces that could stress a joint or overextend a muscle.

Improper warm-up. Properly warming up before vigorous physical activity loosens your muscles and increases joint range of motion, making the muscles less tight and less prone to trauma and tears.

Environmental conditions. Slippery or uneven surfaces can make you more prone to injury.

Poor equipment. Ill-fitting or poorly maintained footwear or other sporting equipment can contribute to your risk of a sprain or strain.

Preparing for your appointment

While you may initially consult your family physician, he or she may refer you to a doctor who specializes in sports medicine or orthopedic surgery.

What you can do

You may want to note down the following information:

Detailed descriptions of your symptoms

Information about medical problems you've had

Information about the medical problems of your parents or siblings

All the medications and dietary supplements you take

Questions you want to ask the doctor

What to expect from your doctor

Your doctor is likely to ask questions, such as:

How exactly were you moving when the injury occurred?

Did you hear or feel a pop or snap?

When did it happen?

What types of home treatments have you tried?

Have you ever injured this part of your body before?

If so, how did that injury occur?

Tests and diagnosis

During the physical exam, your doctor will check for swelling and points of tenderness in your affected limb. The location and intensity of your pain can help determine the extent and nature of the damage. Your doctor might also move your joints and limbs into a variety of positions, to help pinpoint which ligament, tendon or muscle has been injured.

X-rays can help rule out a fracture or other bone injury as the source of the problem. Magnetic resonance imaging (MRI) also may be used to help diagnose the extent of the injury.

Treatments and drugs

Treating sprains and strains depends on the joint involved and the severity of the injury.

Therapy

In cases of a mild or moderate sprain or strain, you should apply ice to the area as soon as possible to minimize swelling. In cases of severe sprain or strain, your doctor may immobilize the area with a brace or splint.

Surgery

In some cases, such as in the case of a torn ligament or ruptured muscle, surgery may be considered.

Lifestyle and home remedies

For immediate self-care of a sprain or strain, try the R.I.C.E. approach — rest, ice, compression, elevation. In most cases beyond a minor strain or sprain, you'll want your doctor and physical therapist to help you with this process:

Rest. Avoid activities that cause pain, swelling or discomfort. But don't avoid all physical activity. Instead, give yourself relative rest. With an ankle sprain, you can usually still exercise other muscles to prevent deconditioning. For example, you could use an exercise bicycle, working both your arms and the uninjured leg while resting the injured ankle on a footrest peg. That way you still exercise three limbs and keep up your cardiovascular conditioning.

Ice. Even if you're seeking medical help, ice the area immediately. Use an ice pack or slush bath of ice and water for 15 to 20 minutes each time and repeat every two to three hours while you're awake for the first few days following the injury. Cold reduces pain, swelling and inflammation in injured muscles, joints and connective tissues. It also may slow bleeding if a tear has occurred. If the iced area turns white, stop treatment immediately. This could indicate frostbite. If you have vascular disease, diabetes or decreased sensation, talk with your doctor before applying ice.

Compression. To help stop swelling, compress the area with an elastic bandage until the swelling stops. Don't wrap it too tightly or you may hinder circulation. Begin wrapping at the end farthest from your heart. Loosen the wrap if the pain increases, the area becomes numb or swelling is occurring below the wrapped area.

Elevation. To reduce swelling, elevate the injured area above the level of your heart, especially at night, which allows gravity to help reduce swelling.

Over-the-counter pain medications such as ibuprofen (Advil, Motrin IB, others) and acetaminophen (Tylenol, others) also can be helpful.

After the first two days, gently begin to use the injured area. You should see a gradual, progressive improvement in the joint's ability to support your weight or your ability to move without pain.
Sprains can take days to months to recover. A physical therapist can help you to maximize stability and strength of the injured joint or limb.

Prevention

Regular stretching and strengthening exercises for your sport, fitness or work activity, as part of an overall physical conditioning program, can help to minimize your risk of sprains and strains. Try to be in shape to play your sport; don't play your sport to get in shape. If you have a physically demanding occupation, regular conditioning can help prevent injuries.

You can protect your joints in the long term by working to strengthen and condition the muscles around the joint that has been injured. The best brace you can give yourself is your own "muscle brace." Ask your doctor about appropriate conditioning and stability exercises. Also, use footwear that offers support and protection.